Poly What?

Polypharmacy, defined by researchers as “the use of more medications than are medically
necessary,” is becoming a significant concern for the elderly, and more
specifically, the hospitalized elderly.According to a
recent article in Kaiser Health News, the consequences of prescribing
unnecessary medications to elderly patients range from medical complications to
heavy financial burdens on the healthcare system.Despite these foreseeable challenges, the
prevalence of over-prescribing is quite high.

A 2005 study evaluated the hospital discharge of 384 elderly patients,
and researchers discovered that 58.6% of the patients took one or more
unnecessarily prescribed drugs.Further,
the Department of Health and Human Services (HHS), in their National Action
Plan for Adverse Drug Event Prevention, cited a 2006 study that revealed 57-59% of adults 65 years of age
and older reported taking five to nine medications, and 17-19% reported taking
10 or more medications.Taking so many
medications increases medical costs and affects a patient’s health.

HHS
reports that adverse drug events (ADEs), injuries that result from the
medical intervention of a drug, account for a third of hospital adverse events
and two million hospital stays annually.Further, while older adults make up 35% of all hospital stays, more than
half of those visits are drug-related complications, and they add around three
days to the average stay.Financially, ADEs
are estimated to incur $5.6 million (1993 USD) in excess hospital costs and
$3.5 billion (2006 USD) in health care costs.Overall, Medicare
beneficiaries suffer the highest risk of acquiring an ADE during a hospital
stay as Medicare reimburses 75% of inpatient ADEs.

The numbers and percentages make it
apparent that polypharmacy creates a large burden on patients and the
healthcare system.Since a great
majority of the population at risk for an ADE is made up of Medicare
beneficiaries, this problem is of particular concern for those who intend to
see Medicare thrive in the future.The
financial uncertainty of Medicare is rooted in the fact that Medicare’s
population is growing substantially while the population
charged with funding the Medicare program is not growing at nearly the same
rate.Accordinly, there is very little
room for superfluous spending on drugs.HHS reports that in 2012 alone, spending on the Medicare Part D
program was $66.9 billion, and that number is projected to increase to $165.1
billion by 2022.Alleviating the
financial burdens of polypharmacy will help prevent Medicare’s potential
solvency.

The question remains then how
hospitals intend to root out the causes of ADEs and polypharmacy in
general.One cause that has received
some attention lately is the lack of coordination and communication between health
care professionals that treat elderly patients.When a patient is admitted into the hospital, a physician may prescribe
medications for the illness presented and any side effects that may arise.The problem arises
when hospital doctors do not account for how long the patient will need the
medication.As a result, medication
prescriptions accumulate over a very short period of time, leaving those
elderly patients susceptible to ADEs, which often leads to another trip to the
hospital.Nationally, older adults are
two to three times more likely to visit the doctor’s office or emergency
department and seven times more likely to have an ADE that requires a hospital admission.

What does this mean for providers
who care for the elderly?It means that
more focus must be paid toward updating and maintaining awareness of the
medications prescribed for patients before, during, and after a hospital
stay.For example, the UCLA Medical
Center in Santa Monica has found a workable remedy to polypharmacy by hiring a
clinical pharmacist to help patients and doctors decide what medications the
patients genuinely need compared to those they can survive without.The clinical pharmacist spends most of his
days updating the medication charts of elderly patients, answering questions
about which medications are best for such patients; and explaining to the
patients themselves what medications they should be taking, how often they
should be taking them, and what each change in dosage or frequency actually
means.The medical center reported that
in the six-month stretch after they brought on the clinical pharmacist to the
geriatric unit, readmissions for drug problems decreased from 22 to three.It’s not hard to
see that having a clinical pharmacist on the team can only benefit patients and
hospitals long term.Especially taking
into consideration recent federal legislation and the general trends towards
value based incentive payments, polypharmacy is certainly an area open to some
cleaning.

Maria Marek is in her second year at the DePaul College of
Law in Chicago. She hopes to achieve a certificate in Health Law in
conjunction with her J.D. upon graduation in 2018. Maria is actively
involved in the Mary and Michael Jaharis Health Law Institute, and is especially
interested in health policy and regulations.